A 67-year old female with a history of diabetes, coronary artery disease, carotid stenosis, hypertension and hyperlipidemia presented with right lower extremity lifestyle-limiting claudication. She denied any nonhealing wounds or sores on her feet. On physical examination, she had a weak palpable right dorsalis pedis pulse and nonpalpable right posterial tibial artery pulse. Noninvasive imaging was performed that demonstrated critically decreased perfusion of the right lower extremity noted at the ilio-femoral, femoral-popliteal, and infrapopliteal levels. Duplex ultrasound was suggestive of moderate stenosis of the right proximal common iliac artery and diffuse right superficial femoral artery stenosis.